A Novel Pattern of Fat Accumulation in HIV-infected Men on HAART

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A Novel Pattern of Fat Accumulation in HIV-infected Men on HAARTNot long after HAART regimens including protease inhibitors (PIs) came into widespread use, HIV positive individuals and their clinicians began reporting unusual body fat changes, including abdominal fat accumulation and fat build-up at the back of the neck ("buffalo hump"). Lipoatrophy, or fat loss in the face, limbs, and buttocks, was later linked to certain nucleoside reverse transcriptase inhibitors (NRTIs).

Example of a Novel Type of Lipoaccumulation in Men Infected With Human Immunodeficiency VirusAffected areas are symmetric and extend from the breasts bilaterally into the axillae as well as posteriorly.(Reprinted from JAMA. 2006;296:766-768)

In a letter to the editor in the August 16, 2006 Journal of the American Medical Association, researchers reported a new pattern of fat accumulation seen in several men in the Multicenter AIDS Cohort Study (MACS), a longitudinal study of more that 5600 men who have sex with men.The novel pattern, as described by the researchers, consists of "bandlike accumulations of lipomatous-appearing tissue extending bilaterally and symmetrically from the breasts laterally into the axillae. In some patients, this fatty tissue extended further posteriorly, with a near-circumferential distribution." As shown in an accompanying photo, the distribution appears as a ring of fat extending from the breasts around to the back, under the armpits.

This fat accumulation pattern was first reported by a MACS clinician in Pittsburgh, and 7 additional cases were subsequently identified among patients in the cohort. All were HIV positive men aged 39-52 years; 6 were white and 2 were Asian/Pacific Islander.Six of the men were on HAART when the unusual fat accumulation was identified, and 4 of these were taking PIs; all 8 men had used PIs in the past. The mean number of years on antiretroviral therapy was 7.8. Three individuals had CD4 cell nadirs below 200 cells/mm3, and one had a past AIDS-defining illness.The researchers further reported that none of the affected individuals had notable soft tissue nodularity, tenderness, evidence of mastitis (breast inflammation), other acute inflammation or infection, new or enlarged axillary lymphadenopathy (enlargement of the lymph nodes in the armpits), or hypogonadism (low testosterone). However, all 8 men did have pre-existing fat accumulation in other areas of the body before the new pattern appeared; 6 also had face and limb lipoatrophy. All had at least one elevated low-density lipoprotein (LDL) cholesterol, total cholesterol, or triglyceride measurement. None had hyperglycemia or diabetes. "We believe that these patients demonstrate a previously unreported manifestation of lipoaccumulation," the researchers wrote. They said they were not able to identify a specific cause, but added, "Since all 8 men had preexisting lipoaccumulation of some kind, this type of lipoaccumulation may represent a progression for some of the individuals."They noted that they had not yet undertaken a systematic review of all MACS participants to see if there might be other similar cases, concluding that, "Comparative evaluation and prospective observation are needed to further characterize this clinical entity."08/29/06

ReferenceF J Palella, J S Chmiel, S A Riddler, and others. A novel pattern of lipoaccumulation in HIV-infected men [Letter to the editor]. Journal of the American Medical Association 296(7): 766-768. August 16, 2006.

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